Pelvic reconstruction after a limb-sparing resection is associated with a high risk of surgical complications and usually should be reserved for patients with a primary bone sarcoma. A pelvic allograft can restore the anatomy and provide good functional results, especially in young patients. Nonunion was the most common allograft-related complication.
Bone allografts can be used in any kind of surgery involving bone from minor defects to major bone loss after tumour resection. This review describes the various types of bone grafts and the current knowledge on bone allografts, from procurement and preparation to implantation. The surgical conditions for optimising the incorporation of bone are outlined, and surgeon expectations from a bone allograft discussed.
Freeze-drying and gamma irradiation are commonly used for preservation and sterilization in bone banking. The cumulative effects of preparation and sterilization of cancellous graft material have not been adequately studied, despite the clinical importance of graft material in orthopaedic surgery. Taking benefit from the symmetry of the left and right femoral heads, the influence of lipid extraction followed by freeze-drying of a femoral head and a final 25-kGy gamma irradiation was determined, with the nonirradiated, nonprocessed counterpart as the control. Five hundred and fifty-six compression tests were performed (137 pairs for the first treatment and 141 pairs for the second). Mechanical tests were performed after 30 minutes of rehydration in saline solution. Freeze-dried femoral heads that had undergone lipid extraction experienced reductions of 18.9 and 20.2% in ultimate strength and stiffness, respectively. Unexpectedly, the work to failure did not decrease after this treatment. The addition of gamma irradiation resulted in a mean drop of 42.5% in ultimate strength. Stiffness of the processed bone was not modified by the final irradiation, with an insignificant drop of 24%, whereas work to failure was reduced by a mean of 71.8%. Freeze-dried bone was a bit less strong and stiff than its frozen control. Its work to failure was not reduced, due to more deformation in the nonlinear domain, and it was not brittle after 30 minutes of rehydration. Final irradiation of the freeze-dried bone weakened its mechanical resistance, namely by the loss of its capacity to absorb the energy (in a plastic way) and a subsequent greater brittleness.
Background: Observational studies have suggested that accelerated surgery is associated with improved outcomes in patients with a hip fracture. The HIP ATTACK trial assessed whether accelerated surgery could reduce mortality and major complications.
Methods:We randomised 2970 patients from 69 hospitals in 17 countries. Patients with a hip fracture that required surgery and were ≥45 years of age were eligible. Patients were randomly assigned to accelerated surgery (goal of surgery within 6 hours of diagnosis; 1487 patients) or standard care (1483 patients). The co-primary outcomes were 1.) mortality, and 2.) a composite of major complications (i.e., mortality and non-fatal myocardial infarction, stroke, venous thromboembolism, sepsis, pneumonia, life-threatening bleeding, and major bleeding) at 90 days after randomisation. Outcome adjudicators were masked to treatment allocation, and patients were analysed according to the intention-to-treat principle; ClinicalTrials.gov, NCT02027896.
Findings:The median time from hip fracture diagnosis to surgery was 6 hours (interquartile range [IQR] 4-9) in the accelerated-surgery group and 24 hours (IQR 10-42) in the standard-care group, p<0.0001. Death occurred in 140 patients (9%) assigned to accelerated surgery and 154 patients (10%) assigned to standard care; hazard ratio (HR) 0.91, 95% CI 0.72-1.14; absolute risk reduction (ARR) 1%, 95% CI -1-3%; p=0.40. The primary composite outcome occurred in 321 patients (22%) randomised to accelerated surgery and 331 patients (22%) randomised to standard care; HR 0.97, 95% CI 0.83-1.13; ARR 1%, 95% CI -2-3%; p=0.71.Interpretation: Among patients with a hip fracture, accelerated surgery did not significantly lower the risk of mortality or a composite of major complications compared to standard care.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.